Pregnancy and neonatal outcomes of HIV infection in pregnant women in Iran: a systematic review and meta-analysis

HIV infection is a major public health concern among pregnant women globally. Beyond the risk of mother-to-child transmission, it can lead to serious complications and negative pregnancy and neonatal outcomes. In Iran, there is currently no comprehensive meta-analysis evidence measuring the adverse pregnancy and neonatal complications of HIV infection among pregnant women. The review objective is to provide pregnancy outcomes, the prevention of mother-to-child transmission (PMTCT), and antiviral therapy (ART) of pregnant women infected with HIV in Iran. The review systematically searched PubMed, Scopus, ISI, Embase, and also the Iranian national databases up to 25th September 2024. Any records that reported pregnancy and neonatal outcomes among pregnant women in Iran were included in the inclusion criteria. The study outcomes included any pregnancy and neonatal implications related to HIV infection in pregnant women, as well as PMTCT, ART therapy, delivery type, and HIV morbidity in spouse. Meta-analysis was carried out to estimate pooled prevalence with 95% confidence intervals (CIs) for all the study outcomes. The study pooled data from 497 pregnant women infected with HIV across seven eligible studies. The majority of participants had no university education, lived in urban areas, and were infected by their spouses. The most frequent adverse pregnancy outcome was abortion. The pooled proportions and 95% CIs for each outcome were: HIV-positive spouses 78% (95% CI: 73–83%), wanted pregnancy 63% (95% CI: 46–80%), ART and/or PMTCT uptake 94% (95% CI: 89–98%), cesarean delivery 88% (95% CI: 77–98%), live birth rate 98% (95% CI: 96–100%), newborns who were HIV positive 1.0% (95% CI: 0.0–1.0%), and newborn prophylaxis 100% (95% CI: 99–100%). Although most pregnant women with HIV are enrolled in PMTCT programs and adverse pregnancy and neonatal outcomes are rare, longitudinal, population-based studies are still needed to better understand the situation of pregnant women with HIV in Iran.